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A 45 year old man is found dead in the orthopedic room of an emergency department. He has no signs of trauma and no past medical history.
What do you think happened?
(BUCKLE UP--IT'S A TOX MURDER MYSTERY THREAD)
What do you think happened?
(BUCKLE UP--IT'S A TOX MURDER MYSTERY THREAD)
Clue #1: The man was hired by the hospital to clean the drain/pipes that was blocked by plaster being washed down the sink by silly residents. 
(Stop washing your plaster down the sink! I see you!! STOP DOING IT! It's nasty and gross
) (2/x)
(Stop washing your plaster down the sink! I see you!! STOP DOING IT! It's nasty and gross) (2/x)
Clue #2: The material used to make the splints was Plaster of Paris. This product is still used today. Check out this 
glowing
review from Amazon (3/x)
glowingreview from Amazon (3/x)
Clue #3: The man was using sulfuric acid
to clean the drain and dissolve the clogged up Plaster of Paris. I'm a toxicology fellow, not a drain declogging expert, what do you want from me? I don't know why they used that. (4/x)
to clean the drain and dissolve the clogged up Plaster of Paris. I'm a toxicology fellow, not a drain declogging expert, what do you want from me? I don't know why they used that. (4/x)
Clue #4: What happens to Plaster of Paris when its gunked up in the pipes? It gets chewed up by bacteria. Under anaerobic conditions, the bacteria can make a nasty, thick (thicc?) calcium sulfide sludge. Mmmm. I imagine the sludge looks like this: (5/x)
Clue #5: Sulfuric acid + Calcium Sulfide = ??? UGHHHHH 
chemistry. Yet, the answer is in there. These two combine in the following chemical reaction, giving us our answer. (6/x)
chemistry. Yet, the answer is in there. These two combine in the following chemical reaction, giving us our answer. (6/x)
THE CULPRIT: 
Hydrogen Sulfide gas was formed by the chemical reaction above and it caused the man to die pretty quickly. Perhaps the only thing abnormal on the patient's skin exam was his silver wedding ring that had tarnished after reacting with the gas. (7/x)
Hydrogen Sulfide gas was formed by the chemical reaction above and it caused the man to die pretty quickly. Perhaps the only thing abnormal on the patient's skin exam was his silver wedding ring that had tarnished after reacting with the gas. (7/x)
Hydrogen sulfide is a colorless gas that classically smells like rotten eggs 
. It gets inhaled into the body and interferes with oxidative phosphorylation and causes cellular hypoxia. What does this translate into? Rapid unconsciousness and cardiopulmonary arrest.
(8/x)
. It gets inhaled into the body and interferes with oxidative phosphorylation and causes cellular hypoxia. What does this translate into? Rapid unconsciousness and cardiopulmonary arrest. (8/x)
Hydrogen sulfide is scary. People will die in groups because whenever someone (not wearing PPE) goes to rescue the victim, they become exposed to the gas and then pass out/die...and the cycle continues.
In fact, at ~1000ppm, breathing will STOP after just 1-2 breaths. (9/x)
In fact, at ~1000ppm, breathing will STOP after just 1-2 breaths. (9/x)
TREATMENT: Moving the victim to fresh air and giving oxygen, in addition to good supportive care and respiratory/ventilatory support, is key. Antidotes such as sodium nitrite work by inducing methemoglobinemia which scavenges the hydrogen sulfide. (10/x)
Anyways, I wanted to do a fun little thread on hydrogen sulfide so I hope you all enjoyed. This was based on a real case report found here: https://jamanetwork.com/journals/jama/article-abstract/362672
If this interests you...the world could always use more toxicologists!
(thread complete!)
If this interests you...the world could always use more toxicologists!
(thread complete!)
